Combination of Anti-VEGF and Laser Photocoagulation for Diabetic Macular Edema: A Review.

Diabetic macular edema (DME) is the most common cause of vision loss in diabetic patients. Thirty years ago, the Early Treatment Diabetic Retinopathy Study (ETDRS) demonstrated that focal/grid laser photocoagulation reduces moderate vision loss from DME by 50% or more; thus, macular photocoagulation became the gold standard treatment for DME. However, with the development of anti-VEGF drugs (bevacizumab, ranibizumab, and aflibercept), better outcomes were obtained in terms of visual acuity gain and decrease in macular thickness in some studies when antiangiogenic drugs were administered in monotherapy. Macular laser therapy may still play an important role as an adjuvant treatment because it is able to improve macular thickness outcomes and reduce the number of injections needed. Here, we review some of the clinical trials that have assessed the efficacy of macular laser treatment, either as part of the treatment protocol or as rescue therapy.

Management of Vision-Threatening Complications of Vasoproliferative Tumors of the Retina.

AIMS: To report the management of vision-threatening complications of vasoproliferative tumors of the retina. METHODS: Clinical records of 31 eyes of 30 patients treated at our centers from 1998 through 2013 were reviewed. The main outcome measures included: type of treatment, tumor regression, tumor relapse and final visual acuity. RESULTS: Seventeen patients (57%) underwent vitrectomy for epimacular membranes (n = 10), rhegmatogenous retinal detachment (n = 2), vitreous hemorrhage (n = 2), tractional retinal detachment (n = 1), serous retinal detachment (n = 1) and subhyaloid hemorrhage (n = 1). After the initial treatment, 10 additional surgeries were performed for vitreoretinal complications. Tumor activity was treated in all eyes either with photocoagulation or cryotherapy. Control of tumor activity was achieved in all cases, after treatment of recurrences. There were no statistically significant differences between initial and final visual acuity (p = 0.437). Recurrence showed a statistically significant association with the presence of proliferative vitreoretinopathy (p = 0.024), tumor thickness (p = 0.026), basal diameter (p = 0.031), and use of photocoagulation alone as initial treatment (p = 0.006, logistic regression). CONCLUSION: In our series, more than half of vasoproliferative tumors of the retina required surgery as the initial treatment. Recurrence was associated with tumor size, presence of proliferative vitreoretinopathy, and use of photocoagulation alone as the initial treatment.

Endoresection of a high equatorial choroidal melanoma.

PURPOSE: To describe previously unreported endoresection of a high equatorial choroidal melanoma. METHODS: Surgical case report imaged with wide-angle retinography and angiography, ecography, optical coherence tomography, and a short video of surgical procedure. RESULTS: The authors describe a 9.68-mm thick mushroom-shaped equatorial melanoma, which was successfully treated by endoresection. A wide-field lens and scleral indentation allowed complete tumor removal by the vitrectomy probe. Liquid perfluorocarbon stabilized the retina, therefore laser endophotocoagulation was applied to tumor margins and the scleral bed. Silicone oil was left as a tamponade, and a ruthenium-106 plaque for radiation therapy was sutured to the episclera. Eleven months after endoresection surgery, there were no signs of systemic or local recurrences. CONCLUSION: Endoresection of an equatorial choroidal melanoma was shown to be a safe technique in this patient, allowing the preservation of anatomy and function of the eye. It should be considered as an option for the treatment of large equatorial choroidal melanomas.